Total spondylectomy for primary tumor of the thoracolumbar spine

Study Design: Six patients with primary malignant tumor of the thoracolumba r spine who underwent total spondylectomy (TS) by en bloc resection were re viewed retrospectively. Objectives: To report surgical technique and preliminary results of TS and to evaluate its oncological curability. Setting: Japan. Methods: Six patients were treated by TS by er bloc resection of the verteb ral tumor. TS through a posterior approach was performed in three cases (T1 osteosarcoma, L1 osteosarcoma and L1 chordoma) and in the others through a single stage anterior and posterior combined approach (T6-8 recurrent gian t cell tumor, L4 chordoma and L5 giant cell tumor). Surgical margins of the specimens were evaluated histologically. All patients were followed, and t heir status was evaluated by clinical and imaging studies. Results: There were no complications related to surgery. Programmed sacrifi ce of nerve roots were performed in three cases for oncologic excision. A w ide surgical margin was achieved in one case, a marginal one in four, and a n intralesional margin in one. Five patients were alive without evidence of tumor and one was alive with disease at follow-up evaluation after 2.0-4.8 years. Local recurrence was found in one case of T1 osteosarcoma with an i ntralesional margin. Conclusions: These preliminary results suggested that TS is an effective pr ocedure in control of local recurrence with acceptable complications.